More is not always better

When it comes to learning strategies to reduce disruptive child behavior, more is not always better, according to a new study by developmental psychologists.

Disruptive behavior in early childhood — for instance, temper tantrums, physical aggression such as attacking other children, and defiance or resistance to authority — can at times be developmentally appropriate and reflect a child’s growing sense of autonomy. However, when disruptive behavior is both frequent and intense, it can indicate emotional and behavioral regulation problems.

Many studies have explored the effectiveness of training programs that teach parents strategies to reduce or prevent disruptive behavior, using randomized trial methods. The two most common types of strategies involve relationship building, which gives the child unconditional positive attention, and behavior management, which rewards positive behavior, and nonviolently disciplines children for disruptive behavior.

A new meta-analysis by Patty Leijten, G.J. Melendez-Torres, Frances Gardner, and colleagues includes more than 150 trials of parenting programs to determine whether the combination of both strategies is more effective in sustainably reducing disruptive child behavior.

“Although the two strategies place different emphasis on the role of positive parental attention, relationship building and behavior management strategies can be implemented at the same time. Indeed, many parenting programs teach parents both types of strategies,” said study author Patty Leijten, Assistant Professor of Child Development and Education at the University of Amsterdam. “In our study, we tested whether this is more effective than teaching parents only behavior management strategies.”

Leijten and her colleagues aimed to assess a popular theoretical model on parenting program components, what they call the “golden couple hypothesis,” which integrates both relationship enhancement and behavior management skills. Parents should first learn how to build a warm and supportive relationship with their child through activities — for example, a daily playtime where the child takes the lead without parental guidance or criticism. Then, they focus on rewarding their child’s positive interactions with attention and praise, while nonviolently disciplining children for disruptive behavior (e.g., ignoring temper tantrums).

The researchers identified randomized trials of parenting programs for reducing disruptive behavior in children with an average age between 2 and 9 years. They classified each trial as teaching relationship enhancement in addition to behavior management, versus behavior management alone, and whether it was situated in a treatment or prevention setting based on whether children had already developed disruptive behavior. Treatment studies included children who were diagnosed with externalizing behavior disorders, referred for disruptive behavior, or scored above a certain cut-off on a measure of disruptive child behavior.

The meta-analysis included a total of 13,478 children from 156 studies, from 20 countries, with 44 percent of parenting programs teaching relationship enhancement in addition to behavior management.

“We found that when children already show severe disruptive behavior, their behavior improves most when parents are taught to use both relationship building and behavior management strategies with their child,” said Leijten. “In contrast, when children had not yet developed disruptive behavior, their behavior improved most when parents were taught behavior management specifically.“

“Some parents may already have their own strategies to maintain a positive relationship with their child. These strategies might get disrupted if professionals teach parents other methods.”

The results suggest that teaching parents relationship enhancement skills may be unnecessary when parent-child relationships are not distorted by disruptive behavior. Many of these parents may already have their own strategies to maintain a positive relationship with their child. These strategies might get disrupted if professionals teach parents other methods.

“Most parenting programs in prevention and treatment settings teach parents the same parenting skills. This is based on the assumption that the same skills that help parents reduce severe levels of disruptive behavior in their children also help parents who want to prevent disruptive behavior in their children,” she said. “Our findings show that this is not necessarily the case and highlight the need to carefully match the content of parenting programs to the needs of individual families. Not all families need the same, and more is not always better.”